What You Need to Know About Shoulder Arthritis
Did you know that sustaining a shoulder dislocation from a traumatic event puts you at risk for developing osteoarthritis of the shoulder later on in life?
Well, not to worry if this happened to you as a young adult while playing sports, or more recently from a slip and fall injury. Many Americans suffer from shoulder arthritis but very few actually require a joint replacement. As a matter of fact, the frequency of shoulder replacements in the United States is one-tenth the number of hip replacements or knee replacements performed annually. Because humans do not walk on all fours, an arthritic shoulder can be tolerated and compensated for much longer than an arthritic hip or knee.
Many patients who have developed arthritis in their shoulder have noted a very slow and subtle loss of motion that occurs progressively over time. This is usually painless. The first signs frequently are difficulty reaching behind your back to wash your back or perform other activities of daily living, such as hooking a bra. Early arthritis patients are easily able to treat intermittent flare-ups of pain with over-the-counter pain medications and remedies or anti-inflammatory medication. These medications and treatments are usually used for two-to-three weeks on average and then the shoulder returns to baseline.
If you have noted these symptoms and have a history of shoulder dislocation, then you may be developing shoulder arthritis. Treatments that you can do on your own include stretching and strengthening regimens that do not require formal visits to a physical therapist. However, you may wish to see a physical therapist or an athletic trainer for an evaluation and recommendations on a home-based treatment program. Stretching exercises performed daily can help prevent stiffening of the shoulder, which can be a source of pain. Gentle strengthening exercises of the muscles around your shoulder blade and shoulder girdle have been noted to be very helpful in preventing pain and flare-ups, and maintaining upper extremity function. Many people have found yoga exercises, tai chi exercises, and basic exercises with light dumbbells to be very helpful.
If you have begun to develop squeaking of your shoulder as you rotate your arm at waist level, or if you have noted crunching or clunking with these motions, then the arthritic change has progressed beyond mild and is now has moved into the moderate to severe category. This still does not necessarily mean that you need a shoulder replacement. Continuing a pain-free exercise program is very beneficial at prolonging the life of your shoulder. However, there may come a time when this pain in your shoulder is not controlled with simple anti-inflammatory medications and exercise. At this point, additional non-operative treatments are available, including corticosteroid injections, which have been shown to be very helpful at alleviating symptoms, sometimes for a prolonged period of time.
In the event that corticosteroid injections do not provide adequate relief, arthroscopic surgery might be the right option. A shoulder arthroscopy for arthritis entails removing loose bodies (small free floating pieces of bone and cartilage – like a rock in your shoe), cleaning up your arthritic joint and any degenerative tears to the soft tissues around the shoulder, and may also involve removing the biceps tendon from the inside of shoulder joint. The biceps tendon can be significant pain generator, especially when it becomes partially torn, thickened and degenerative as a result of the arthritic change in the shoulder.
If you are not a candidate for this procedure, then you might consider a shoulder replacement. Because shoulder replacement operations are rather uncommon, you may have spoken with patients who have had other types of shoulder surgery done – for example, a rotator cuff repair. Such patients may have had a very difficult time with postoperative rehabilitation. Shoulder replacement surgery is a different operation from rotator cuff repair surgery and the rehabilitation process is not the same. In addition, the postoperative recovery is completely different, and unlike rotator cuff repair surgery, shoulder replacement is relatively pain-free once the incisional pain is gone. Because the arthritic joint, which is the major source of pain in the shoulder, is replaced, patients feel great relief after the operation. Usually, an overnight stay in the hospital is required, but most patients do go home the following day.
If you have been diagnosed with shoulder arthritis or are concerned you may have an arthritic shoulder, for an appointment, please contact the schedulers at the Orthopaedic Specialty Center at 802-847-4690. We would be happy to provide a consultation.
Adam Shafritz, MD, is an Upper Extremity Surgeon at Fletcher Allen Health Care and an Associate Professor at the University of Vermont College of Medicine. Watch a short video interview with Dr. Shafritz.
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